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Required fields in red Membership Category Patron (includes dinners and breakfasts for alum) $475 Dinner Only Patron (includes dinners only for alum) 420 Patron Couple (includes dinners and breakfasts for alum and dinners for spouse) 710 Graduate Patron Couple (includes dinners & breakfasts for 2 alums) 730 Regular (will pay for any dinner events, no admission to Patron breakfasts) 80 Senior Member (age 70 and up) 55 Recent Graduate (MBA 2005-2007) 60 Deferred Admit 50 Credit Card: American Express Mastercard Visa Card number: Exp. date: Name on card: Name: Graduation Year: Home Address: City: State: Zip Code: Home Phone: Employer: Business Address: City: State: Zip Code: Business Phone: Fax: E-Mail: Function: None Accounting/Control Consulting Fundraising/Development Engineering Finance: Underwriting/Advising Finance: Corporate Finance Finance: Investment Management Finance: Lending Finance: Mergers & Acquisitions Finance: General Finance: Research Finance: Sales & Trading Finance: Treasury/Analysis General Management Homemaker Human Resources Professional Advising-Investment Information Services Logistics Professional Advising-Law Marketing: Brand/Product Management Marketing: Communications Professional Advising-Medicine Marketing: General Manufacturing/Operations Marketing: Research Marketing: Sales Other Purchasing Product Development Project Management Public Relations Planning/Other Corporate Services Research and Development Professional Advising-Religion Teaching Position: None -- TOP OFFICER LEVEL -- Chairman of the Board Chief Executive Officer, Senior Executive Officer President Vice Chairman Managing Director, Executive Director Managing Partner, Senior Partner Chief Operating Officer Group Managing Director Member of Board -- TOP OFFICER OF SUBSIDIARY OR DIVISION LEVEL -- Div./Dept. Chairman, Regional Chairman Div./Dept. Chief Executive Officer Div./Dept. President, Group President, Reg. President -- SENIOR EXECUTIVE OFFICER LEVEL -- Senior Vice President Chief Financial Officer Chief Information Officer Partner, General Partner, Limited Partner Principal Group Vice President, Exec or Sr Exec Vice President -- OTHER CORPORATE OFFICER LEVEL -- Treasurer, Controller, Comptroller Secretary, General Counsel Vice President, Corporate Vice President Div./Dept. Vice President, Regional Vice President -- GENERAL MANAGER, DIRECTOR LEVEL -- General Manager, Group Manager Manager, Director Associate, Assistant, Assistant to, Deputy, Deputy to Educator: President, Dean, Associate Dean Educator: Teacher, Professor, other administrators Government Officials: Cabnt, Sen, Rep, Ambass, Govr Government Officials: all others Military: Gen. , Lt., Major or Brigadier Gen, Admiral Military: all others Industry: None Aerospace/Automotive/Transportation Equipment Energy/Extractive Minerals Heavy Capital Intensive/Raw Materials Suppliers Paper and Forest Products Textiles and Apparel Chemicals/Pharmaceuticals/Medical Products Chemicals Pharmaceuticals Medical/Health Care Devices Biotechnology High Technology/Electronics Software Consumer Products Agriculture, Food and Beverage Product and Equipment Suppliers Machinery and Equipment Manufacturers Other Manufacturing Utilities Telecommunications Transportation Real Estate Construction Retailing/Wholesaling/Trading Retailing/Wholesaling Trading Printing, Publishing and other Communications Printing, Publishing Broadcasting Other Communications Commercial Banking Insurance and Diversified Financials Investment Banking/Brokerage Venture Capital Investment Management Professional Services Accounting Advertising Consulting Engineering Advocacy/Legal Services Labor-intensive Services Computer-related Services Entertainment/Leisure/Culture Food Service/Lodging Health Services Social Services Other Services General Government Military Education Religion Foundation/Grant-making Other Non-Profit Highly Diversified-manufacturing & non-manufacturing Highly Diversified-manufacturing Highly Diversified-non-manufacturing Previous Employers: Expertise: Organizations: I prefer my mail sent to residence company
Harvard Business School Club of Northeastern Ohio 1120 Chester Avenue, Suite 470, Cleveland, Ohio 44114-3514 Phone: (216) 696-2437 Fax: (216) 696-2582 E-Mail: admin@hbs-neo.org © Harvard Business School Club of Northeastern Ohio. All rights reserved. Powered by Dynamics Online
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